Time to Merge Health & Social Care?
Earlier today I asked the Local Government Minister whether should remove the social services function from local government and merge it with the new Local Health Boards.
This question built on my speech last week at the RESEC (Research in Specialist Elderly Care) conference in Bangor where I suggested that government departments ought to be working together in planning for our future care needs, and that they should be examining the regulatory framework & inspection regime to see whether it’s fit for purpose.
For some, giving the LHBs responsibility for social services would be a controversial step, especially those running our county councils; for others who are tired of poor performance in the delivery of social care this would be a sound move to make.
One of the biggest barriers to strategic planning and the provision of seamless care is the fact that two organisations are responsible for people in the health and care sectors. A person in hospital is the responsibility of the NHS, if they are discharged with a care package they will have the input of usually both health and social care workers, who in turn are accountable to the NHS and local government. In theory there’s no reason why this shouldn’t work but the practicalities are quite different.
The first problem is at the point where a person is capable of being discharged to their own home but the discharge planning is flawed. According to hospital managers local government are slow to put in place an appropriate package of care, I suspect they are right. However many of our hospitals are also slow to ensure that the district nursing service is lined up and involved in advising on the appropriateness of the discharge. Age Concern told me this week that they are seeing an increased number of unsafe care packages being put in place. This is a disgrace for a nation that purports to care about the elderly.
The second problem is for those who require nursing care in a residential home. The experience of most families is the long drawn out battle between LHBs and local government over who should pay the care home costs where a person has, for example, dementia. By 2050 there will be 1.7 million people in the UK with dementia, an increase of 81%, and for many a care home is needed. Having had constituency experience of the disagreements between statutory bodies over funding this is a big issue. The dispute is usually over the actual level of nursing care required for the patient, a rather stale and impersonal spat between two organisations charged with caring for the individual.
Planning for our future care needs is one of the greatest challenges we face, we must be bold. Who exercises these functions is an important part of that debate.